Dr. Brian Gill on spine surgery ramp-up, how coronavirus will change care

Alan Condon -  

Brian Gill, MD, MBA, a spine surgeon with Nebraska Spine Hospital in Omaha, spoke to Becker's Spine Review about how his practice is preparing for the return to elective surgeries in Nebraska and how the coronavirus will change spine care.

Note Responses are lightly edited for style and clarity.

Question: How has your practice been impacted by the coronavirus pandemic? 

Dr. Brian Gill: In short, in all aspects. Our practice consists of a surgical department and a pain management department. Both departments have seen a decline in patient volume with a greater decline in the surgical department with the cessation of surgical cases. To make ourselves more accessible, we have increased our use of telemedicine. Our clinic is still open for traditional visits, but we offer telemedicine as an alternative for those patients who are not able to come to the clinic. Provider and staff work schedules have been adjusted to offset the decline. Finally, our practice has taken advantage of several provisions through the CARES Act.

Q: How is your practice preparing for the ramp-up period of surgical cases? How many backlogged cases do you currently have?

BG: Nebraska is resuming elective surgeries as of May 4. We have been developing protocols within our clinic and coordinating with local hospitals to address this ramp-up of surgical cases. We want to make sure that we keep our patients safe. Throughout this pandemic we have continued to see patients who are hurting and need surgery, so our backlog has grown. My estimation is that we have 100-200 cases to schedule. 

Q: What cost-saving measures is your practice taking during the current crisis?

BG: Since the pandemic disrupted our ability to see patients, we have had to adjust work schedules for everyone. Our clinics are starting a bit later and ending earlier to minimize office staff hours. We have had to cut some hours from our employees as the volume has decreased, but we have also been able to keep them employed by having them do other tasks and projects. Several employees have elected to take some time off for personal and family reasons. From a company capital expenditure, we have delayed various projects to preserve cash at this time. We had budgeted purchasing several new pieces of equipment for the office, but this has been put on hold. 

Q: How will the coronavirus change spine care?

BG: I have always been a big proponent of telemedicine, but the insurance regulations had previously limited its widespread use. The pandemic allowed for regulators and insurance companies to loosen the rules allowing for equal reimbursement as an in-person visit. Additionally, we are able to use various forms of technology to connect with patients from phones, tablets, laptops or desktop computers. Hopefully, the adoption of telemedicine will continue making it more readily available in the post coronavirus world.

From a surgical standpoint, surgeons will have to counsel their patients about the risks of COVID-19, especially the elderly. Surgeons will have to be even more diligent in selecting surgical patients, working with family members, and nurse navigators in order to coordinate care for the patient in order to avoid skilled nursing facilities.

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